低中心静脉压在肝癌患者肝切除手术中的应用研究  

The application of low central venous pressure LCVP in hepatic resection

作　　者：林华赋[1] 刘德昭[2] 程芳[1] LIN Huafu;LIU Dezhao;CHENG Fang(Jiangmen Central Hospital,Jiangmen 529030,China;Third Affiliated Hospital of SUN Yat-sen University,Jiangmen 510630,China)

机构地区：[1]江门市中心医院,江门529030 [2]中山大学附属第三医院,广州510630

出　　处：《广州医药》2018年第2期58-62,共5页Guangzhou Medical Journal

基　　金：广东省自然科学基金(2014A030313076)

摘　　要：目的探讨低中心静脉压(LCVP)对肝癌肝切除术的影响及意义。方法选择我院2010年3月—2012年3月期间拟行肝切除术的原发性肝癌患者60例,随机分为LCVP组(30例)和NCVP(30例)。LCVP组术中采用相关技术控制CVP<0.5 k Pa;NCVP组术中CVP和血压控制在基础值10%上下范围内。两组的麻醉方法、切口、切肝方法、输血指征均一致。分别记录:心率、血压、CVP值和血常规;手术时间、手术切除肝组织范围、手术期间各阶段出血量、输注血制品的数量;术后第1、3、7天的肝肾功能以及凝血功能,所需补充的外源性白蛋白量;术后并发症的发生率、住院时间和费用。结果 (1)2组术前一般临床资料比较均无差异(均P>005)。(2)LCVP组手术时间、手术总出血量、肝离断时出血量、RBC输注量均低于NCVP组(P<0.05);(3)2组术后肝功能、肾功能指标比较无差异(P>0.05),LCVP组患者术后白蛋白补充量比NCVP组减少(P<0.05);(4)2组患者术后肝功能衰竭、膈下积液、胆瘘、大量腹水、肺部感染、空气栓塞、死亡的发生率比较,均无差异(P>0.05);(5)LCVP患者住院天数、住院总费用均比NCVP组减少(P<0.05)。结论术中应用LCVP可减少肝癌肝切除术中出血量,缩短住院时间和住院费用,有利于患者的术后恢复。Objective To evaluate the effect of LCVP applied during the operation of hepatectomy.Methods Sixty patients underwent hepatectomy were enrolled in the study from March 2010 to March 2012 in our hospital which were randomized into LCVP group and normal CVP(NCVP)group by the sealed envelope method.CVP was kept<0.5 kPa during entire procedure of hepatectomy in LCVP group,and the value of CVP and blood pressure were controlled within 10%of the baseline.The same anesthesia,incision and hepatectomy technique and indications of blood transfusion in LCVP group were undertaken as those in NCVP group.Intraoperative CVP,blood pressure,HR and blood routine were recorded.The time of operation,the amount of bleeding,the extent of removed hepatic tissue,the amount of transfused blood products,liver and renal function index,and coagulation function index were detected on the 1st,3rd and 7th day after operation.Also the supplement of albumin,the rate of postoperation complications and the length of hospital stay and the expense in hospital were recorded.Results ①The general clinical data of patients were similar in the two group(P>0.05).②The operation time,total bleeding volume,bleeding volume and RBC infusion volume in LCVP group were significantly lower than those in group NCVP(P<0.05).③There were no significant difference of postoperative liver and renal function index between the two groups(P>0.05).But the supplement of albumin in LCVP group after operation was significant less than that in NCVP group(P<0.05).④There were no significant difference of the postoperative complication,the length of hospital stay and the expense in hospital between the two groups(P>0.05).Conclusions The application of LCVP in hepatectomy cause less blood loss,shorten the length of hospital stay and decrease the expense in hospital,which is beneficial for the postoperative recovery.

关 键 词：原发性肝癌 低中心静脉压 肝切除术 

分 类 号：R735.7[医药卫生—肿瘤]